OPOIDS POISONING:Morphine

OPOIDS POISONING

• Opioids  (opiates)  are derived from  the  poppy plant.
• Opium  is  the  dried  juice  obtained  by incision  of  the  unripe capsule  of  the  white  poppy, Papaver  somniferum.
• Natural  derivatives  of  opium  are  morphine,  heroin  and cocaine.
• Heronin  (smack  or  brown  sugar)  is  the  most  commonly  abused  opioid and 2nd  most  commonly  abused  substance, after alcohol

Morphine  (or  heroin) intoxication  (overdose/toxicity)

Morphine/heroin poisoning  has three  stages  :

1. Stage  of  excitement  –  Hallucination,  euphoria, maniacal  features.
2. Stage of stupor  –  Headache,  nausea,  vomiting,  incapacity  for  exertion,  a  sense  of weight  in  limbs,  giddiness,  drowsiness,
3. Stage  of coma  – Abolished  reflex,  Pin point  non  reacting  pupil,  All secretions  are  suspended  except sweat, Hypotension, hypothermia,  cyanosis, bradycardia, slow  and  shallow breathing, respiratory depression and  paralysis.

• There  may  be  white froth  from mouth,  in  PM  examination.
• Fatal dose of morphine is 200 mg

Morphine (or  heroin)  withdrawal symptoms:

Treatment

A)  Treatment  of  acute  intoxication  :

• IV  naloxone  is  the  DoC for  poisoning, followed  by  oral naltrexone  for  maintenance  therapy.
• IV  nalmefene  is  an  alternative  to  IV naloxone.

B)  Treatment  of withdrawal:

1. Methadone  is  the  drug of  Choice.
2. Clonidine, buprenorphine , pentazocin.